What is Point-of-Service Plan (POS)

A point-of-service plan (POS) is a type of managed-care health insurance plan that provides different benefits depending on whether the policyholder uses in-network or out-of-network health care providers. A POS combines the features of the two most common types of health insurance plans, the health maintenance organization (HMO) and the preferred provider organization (PPO). POS plans only represent a small share of the health insurance market; most policyholders have either HMO or PPO plans.

BREAKING DOWN Point-of-Service Plan (POS)

A point-of-service plan is like an HMO in that it requires the policyholder to choose an in-network primary care doctor and to get referrals from that doctor if they want the plan to cover a specialist’s services. And a point-of-service plan is like a PPO in that it still provides coverage for out-of-network services, but the policyholder will have to pay more than if they used in-network services. However, the POS plan will pay more toward an out-of-network service if it is referred by the primary care physician than if the policyholder goes outside the network without a referral. The premiums for a POS plan fall in between the lower premiums offered by an HMO and the higher premiums of a PPO.

POS plans require the policyholder to make co-payments, but in-network co-payments are often just $10 to $25 per appointment. POS plans also do not have deductibles for in-network services, which is a significant advantage over PPOs. Also, POS plans offer nationwide coverage, which benefits patients who travel frequently. A disadvantage is that out-of-network deductibles tend to be high for POS plans, so patients who use out-of-network services will pay the full cost of care out of pocket until they reach the plan’s deductible. In addition, a patient who never uses a POS plan’s out-of-network services would probably be better off with an HMO because of its lower premiums.

The Relative Unpopularity of Point-of-Service Plans

Though POS plans combine the best features of HMOs and PPOs, they hold only a relatively small market share. One reason may be that POS plans are marketed less aggressively than other plans. Also, price might be an issue. Though POS plans can be up to 50 percent cheaper than PPOs, premiums can cost as much as 50 percent more than for HMOs. On the other hand, POS plans can be up to 50 percent cheaper than PPOs. POS plan details can also be challenging. Plans can be confusing, and many consumers don’t understand what the costs are.